Our client is one of the leading insurance firms focusing on advancing healthcare and insurance through smarter processes and digital innovation. They are seeking a highly experienced Claims Consultant with deep expertise across the end-to-end healthcare claims ecosystem.
This is a client-facing, strategic role that combines claims domain knowledge, medical understanding, and consulting expertise, with a strong focus on technology-driven transformation. The ideal candidate is a compelling storyteller who can translate complex claims processes into actionable strategies and manage senior stakeholders effectively.

Key Areas of Responsibility
Claims Advisory & Transformation

• Provide expert advisory on end-to-end claims processes, including submission, adjudication, payment, and reconciliation.
• Analyse current state processes across providers, TPAs, and insurers to identify inefficiencies and risks.
• Design and implement claims transformation strategies, leveraging digital tools, automation, and data analytics.

Technology & Innovation Strategy

• Develop technology-enabled solutions to improve claims efficiency, accuracy, and customer experience (e.g., AI/ML, automation, digital platforms, APIs).
• Translate business requirements into technical specifications, working closely with IT, product, and engineering teams.
• Stay abreast of emerging insurtech and healthtech trends and apply them to practical client solutions.

Client Engagement & Stakeholder Management

• Act as a trusted advisor to senior stakeholders.
• Lead client workshops, discussions, and presentations, effectively articulating complex ideas through compelling storytelling.
• Manage cross-functional stakeholders across business, medical, and technical teams.

Process Optimisation & Governance

• Establish best practices for claims governance, compliance, and fraud detection.
• Define KPIs and frameworks to monitor claims performance, cost containment, and service levels.
• Drive continuous improvement initiatives across the claims lifecycle.

Requirements:

• Solid experience in insurance, healthcare, claims or consulting related roles (typically 7+ years)
• Bachelor's degree in Healthcare, Insurance, Business, or related field.
• Familiarity with claims systems, workflows, or healthcare operations
• Medical, clinical, allied health, nursing, or medical auditing background is highly advantageous, but not required.
• Familiarity with technical concepts and tools (e.g., APIs, data models, automation tools, AI/ML in claims).
• Ability to bridge business and technical teams effectively.
• Experience working with data, automation, or digital tools is an advantage.
• Consulting or claims-related project-based experience is a plus.

If you're interested in this role, click 'apply now' to forward an up-to-date copy of your CV.

If this job isn't quite right for you, but you are looking for a new position, please contact us for a confidential discussion on your career.